1例复发/难治弥漫性大B细胞淋巴瘤自体造血干细胞移植桥接CAR-T治疗的护理  

Nursing care of a patient with recurrent/refractory diffuse large B-cell lymphoma undergoing autologous hematopoietic stem cell transplantation bridging CAR-T therapy

作　　者：赵林娣 赫洋[2] ZHAO Lindi;HE Yang(Department of Nursing,Ruijin Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200025,China;Department of Hematology,Ruijin Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院护理部,上海200025 [2]上海交通大学医学院附属瑞金医院血液科,上海200025

出　　处：《上海医药》2025年第2期67-71,89,共6页Shanghai Medical & Pharmaceutical Journal

基　　金：国家自然科学基金资助项目(82300154)。

摘　　要：本文总结1例TP53突变合并多基因异常所致复发/难治弥漫性大B细胞淋巴瘤AAⅣ期患者行自体造血干细胞移植桥接嵌合抗原受体T细胞(CAR-T)免疫治疗的预见性护理,包括多措施联合预防右上肢肿块处皮肤破溃及压疮的发生;疼痛评估及WHO癌痛三阶梯治疗基本原则做好患者疼痛管理;个体化制订专属的心理护理方案;严格消毒隔离预防移植后低细胞期感染发热,鉴别细胞因子释放综合征反应;制定个体化的CAR-T治疗神经毒性评估方法等。患者干细胞移植后30d出院,右上肢肿块明显缩小,臂围基本同左上肢,病情稳定。This study summarizes proactive nursing strategies for a patient with relapsed/refractory diffuse large B-cell lymphoma(DLBCL,Ann Arbor stageⅣ)caused by TP53 mutation and multiple genetic abnormalities,who underwent autologous hematopoietic stem cell transplantation bridged with chimeric antigen receptor T-cell(CAR-T)therapy.Key interventions included multi-modal prevention of skin breakdown and pressure ulcers at the right upper limb mass site,pain management adhering to WHO analgesic ladder principles,personalized psychological support,strict infection control during neutropenic phase with continuous monitoring of cytokine release syndrome(CRS),and tailored neurotoxicity assessment for CAR-T therapy.The patient achieved clinical stabilization and was discharged 30 days post-transplantation,demonstrating significant reduction of the right upper limb mass with arm circumference nearly matching that of the left side.

关 键 词：弥漫性大B细胞淋巴瘤 自体造血干细胞移植 CAR-T治疗 预见性护理 

分 类 号：R473.73[医药卫生—护理学] R733.4[医药卫生—临床医学]